Finding My Voice

Regardless of where you are in your medical training or your level of experience with advocacy, know that you have a unique insight to some of the most fundamental issues in your community. You have a voice - now's the time to use it!

As emergency physicians we are extensively trained in the art of decision-making. I was once naïve enough to believe that the only stakeholders involved in medical decision-making were patients and their treating physicians. However, I can no longer ignore the power of external influences. Behind each decision is a complex web of resources, funding, cultural beliefs, social determinants, and policy that often pulls my patients in directions I do not feel is best for their health. Determined to understand these extensive barriers, and the numerous ways in which they impact care at the level of both individual patients and communities, I developed a plan to participate. My hope is to share my experience as a brand-new voice in advocacy and challenge residents around the country to jump into the waters as well.

With each new venture, the hardest part is often getting started. I am thankful to have the opportunity to be a part of the Texas College of Emergency Physicians Leadership and Advocacy Fellowship, a program dedicated to introducing young physicians to advocacy efforts and providing mentorship on how to both protect and elevate our profession. Many other states have similar programs, and I encourage you to explore the opportunities in your state as a senior resident or junior attending! As part of the fellowship I attended numerous state and national meetings throughout the year, including the annual ACEP Leadership & Advocacy Conference (LAC) in Washington, D.C. Just as in the ED, my educational experience at LAC unfolded as I was tossed in to the action - preparing to discuss one of the specific issues highlighted at the meeting: securing appropriate access to mental health services in emergency departments. I am convinced that every emergency physician has experienced the frustration of a patient presenting with a mental health emergency, only for that patient to be stuck in a noisy, cramped ED for hours on end while a proper disposition is pending. Work on this crucial issue has already begun. In fact, a monumental bill by Rep. Raul Ruiz, MD, of California titled “Improving Mental Health Access from the Emergency Department Act of 2019” was introduced to the House in May. This example is one of many that illustrates the impact of policy on not only the emergency care of patients, but also on the educational experience of EM residents.

There were many excellent lectures at LAC, but I was particularly taken by a talk from Bradford Fitch, president and CEO of the Congressional Management Foundation. His presentation focused on how to successfully initiate and cultivate relationships with your elected representative. As a budding advocate I would liken this skill to calling consultants in the ED - know the facts, be concise, be flexible, and always be polite! I wanted to share this advice with residents who may think such action is intensive or unrealistic. The following is a breakdown of how to successfully prepare to meet with your representative, using the pertinent example of addressing the national mental health crisis:

  1. Make contact: While hundreds of emergency physicians arrive at Capitol Hill each year in the spring, it may not always be feasible to travel to D.C. Each representative has a local office within his or her district and may hold town hall meetings as well. Explore other forms of communication, including phone calls, letters, and email.
  1. Prepare: The biggest aspect of preparation is knowing your audience. Your representative will want to know how the issue affects their constituents, as well as any economic impact. Are many of your patients in this representative’s district? How often does a lack of mental health resources cause a delay in care? Can you estimate a degree of burden the lack of resources creates, including potential cost? If given more funding for this initiative, what solutions do you propose?
  1. Refine your expectations: Your representatives are quite busy. It is possible that you will be meeting with their staff. However, do not be deterred! The talented staff members with whom I met were incredibly knowledgeable about current legislation, viewpoints, and needs within their districts.
  1. Put your best foot forward: Show your passion for your patients, but try not to come across as demanding or accusatory. As a doctor, you have an incredibly unique and privileged perspective of society. Caring for patients who are experiencing a psychiatric emergency can be as raw an encounter as anyone can experience. Channel your emotions to the best of your ability and actively recruit your legislators as allies.
  1. Follow up: Because numerous bills are introduced each session, advocating for a cause you believe in is rarely a singular effort! Choose a form of communication you are comfortable with and remind your representative why action should be taken. It can be particularly crucial to do this in a timely manner if a bill has already been introduced. Did you recently care for a patient with a psychiatric emergency? Did you identify barriers to optimal therapy? Share that patient story with your representative!

Traveling to D.C. for LAC and participating in meaningful conversations with congressional staff has opened my eyes to a whole new way to care for my patients. But what’s next? Must I wait an entire year to experience that contagious energy again? How do I keep the momentum going?

In addition to national government, I would strongly consider involvement in state government. Beyond being more accessible geographically, it may be more feasible to make headway at a state level and focus on issues that are uniquely important to your area. Many issues critical to us as emergency physicians are primarily dealt with on a state level including Medicaid programs, insurance regulations (such as the “prudent layperson” standard) and regulations involving opioid use and abuse. Sharing another example from my home state, the Texas Medical Association holds monthly “First Tuesdays” in Austin when the Texas Legislature is in session. Doctors from across specialties come together to advocate for optimal patient care and appropriate work conditions for our doctors. Consider searching for similar programs in your own state!

Regardless of where you are in your medical training or your level of experience with advocacy, know that you have a unique insight to some of the most fundamental issues in your community. I challenge you to apply the skills you have learned in the ED to a new arena and be a megaphone for your patients and colleagues. If this article has piqued your interest, be sure to check out EMRA’s Advocacy Handbook for a deeper dive! Hope to see you at LAC 2020!

**Shout-out to ACEP Board of Directors member Alison Haddock, MD, FACEP, for editorial assistance.

1. How to Set up a Meeting with Your Member of Congress. Families USA. Feb. 2017.
2. Hunsaker K. First Tuesdays: A Personal Profile. Texas Medical Association, 9 Oct. 2018.
3. Johnson K. Advocacy 101: Talking with Your Congressman. One. 6 Mar. 2015.
4. Schlicher N and Haddock A. Emergency Medicine Advocacy Handbook. 5th ed. Emergency Medicine Residents' Association: Dallas, TX;2019.
5. Turner S. CMF Trains Citizen Advocates on What To Do Before, During, and After Meetings. Congressional Management Foundation, 7 Mar. 2018.

Related Articles

Health Policy Journal Club: Under-Utilizing CT Scans in Brain Injury

Just over half of brain injury patients got recommended scans; uninsured fared worse.

Health Policy Journal Club: Socially Constructed Criticisms

Jasmeen Kaur 05/06/2020
One more reason to pay attention to health policy: Your race or ethnic background may play a role in analyzing whether you receive pain treatment when seeking emergency medical services.